THE global monkeypox enterprise continues. Hardly a week passes without some link to an article about ‘Mpox’, as we are supposed to call it, in Global Health Now. This week we were treated to two links on the same day. And it was all, apparently good news.
The first link from the CIDRAP newsletter of the Center for Infectious Disease Research & Policy at the University of Minnesota reported that, due to intensified public health measures, monkeypox cases were declining in Africa. The measures included surveillance and contact tracking.
But don’t relax yet as the disease continues to spread in some places and show up in others for the first time. Clearly, the surveillance and contact tracing will have to be intensified. If only there were a vaccine; and guess what? There is.
On the home front in the United States, there is more good news. Also reported in CIDRAP, it seems that more adults are now willing to receive the monkeypox vaccine than in 2022. Mind you, this still amounts only to 58 per cent of the population surveyed by the University of Texas.
At least a significant minority of people are not falling for the propaganda. And why should they? Monkeypox vaccines are unnecessary and, what is more, the companies making them either do not know, or will not report, how (in)effective they are.
In developed countries such as the United States, monkeypox is an unpleasant but mild infection which leaves most people unscathed and from which very few die. Those who die are the usual suspects: the immunocompromised. And, similarly to covid, the line between ‘with’ and ‘of’ the infection is extremely blurred. Many of those who are immunocompromised have advanced or untreated HIV and will also have been men who had anal sex with men. This group is especially vulnerable to monkeypox.
Towards the end of last year, in the United States, 63 people had died with or of monkeypox. That represents 0.000019 per cent of the United States population of the 34,063 (0.0103 per cent) who had monkeypox. Even considering a two to ten times underreporting factor for monkeypox (68,126 to 340,630, respectively) this yields an infection fatality rate (IFR) of between 0.092 per cent to 0.018 per cent.
The above figures are only estimates for prevalence, which represents the total number of people with monkeypox at any one time. If we consider prevalence, using CDC (Centers for Disease Control and Prevention) figures, in 2024 only approximately 3,000 people became infected with monkeypox meaning that the annual incidence is only 0.0009 per cent of the population. Hardly a public health emergency.
One of the monkeypox vaccines, the JYNNEOS (also referred to as MVA-BN) is estimated to be between 66 per cent to 89 per cent effective after two doses. These figures refer to relative risk reduction (RRR) which compares the vaccinated with the unvaccinated. But since 2021 during the covid ‘crisis’ we have repeatedly warned in these pages the dangers of referring to RRRs when reporting vaccine efficacy.
The RRR is virtually meaningless based on, as it often is, very low incidences of the disease the vaccine purports to prevent. All it tells you is how much less likely you are to become infected if you are vaccinated compared with someone else who is not. It does not tell you how much less likely you are to become infected if you are vaccinated compared with not being vaccinated, which is the absolute risk reduction (ARR).
Reports of the efficacy of monkeypox vaccines routinely report RRR because, wait for it, those developing and selling the vaccines do not report what the ARR is. They do not report the actual incidence rates of monkeypox in both vaccinated and unvaccinated populations. Without such information, it is difficult to determine the ARR. But let’s give it a go.
Let’s pretend that, like the covid vaccines before them, monkeypox vaccines are 100 per cent effective. We know the incidence rate in the unvaccinated (0.0009 per cent) and we have a figure for the incidence rate in the vaccinated (0 per cent). The formula for ARR = Risk in unvaccinated group (0.0009 per cent) – Risk in vaccinated group (0 per cent). This means that the ARR is 0.0009 per cent. If the efficacy of the vaccine is lower than 100 per cent then the ARR gets even smaller. Not very impressive.
Translating ARR into the number needed to treat (NNT = 1/ARR) to prevent a single case of monkeypox leads us into the realm of pure comedy. If the vaccine is 100 per cent effective, then 111,111 people need to be vaccinated. If the vaccine is 85 per cent effective, then approximately 130,700 need to be vaccinated. Using the figures for IFR calculated above, the NNT to prevent a single death from monkeypox in the United States is between 111million and 556million people.
It is hardly surprising that the manufacturers of monkeypox vaccine do not report the ARRs of their products. For a random individual in the United States population, the value of taking the vaccine is negligible. Nevertheless, at a current 58 per cent of the population willing to receive a monkeypox vaccine that means 191,400,000 may receive at least one dose.
The CDC price for vaccines is $229.50 per dose (for private-sector hospitals it is $270) and for low- and lower-middle-income countries UNICEF have negotiated a price of $65 per dose. Assuming that all the doses in the United States are obtained at the CDC price then, if the 58 per cent of the population keep their word and roll up their sleeves once that represents $44billion in sales. The JYNNEOS vaccine is estimated to cost between $3 to $10 per dose to manufacture, meaning profits of between $42billion and $43billion for a single dose. Double that for two doses.
In any rational cost–benefit analysis, the case for widespread monkeypox vaccination in the general population collapses under the weight of its own numbers. With infinitesimal risk, negligible absolute benefit and astronomical profits, vaccination in this instance appears less about public health and more about perpetuating a self-sustaining industry.
When metrics such as ARR and NNT are quietly omitted – precisely because they expose the futility of mass vaccination – it raises serious ethical questions. Has vaccination become an end in itself? If public health decisions are guided more by political optics, pharmaceutical profit margins and the inertia of global health messaging than by meaningful individual benefit, then the answer is uncomfortably close to yes.
